measures of effectiveness to assure that incident objectives are being achieved. Equally important, ongoing incident pro- filing is invaluable in identifying a sudden change in incident characteristics that could mandate a significant change in response strategies or tactics (e.g., a new or previously unidentified hazard discovered that poses real risk to respon- ders). The Incident Epidemiological Profiling Function also has utility in providing the information to develop an appro- priate time frame for demobilization of assets and final inci- dent stand-down. This is critical to anticipate for the purpose of returning a community to normal operations. Additionally, the function is vital for providing authorities with informa- tion to confidently define and reassure the unexposed population. 9 - 2 Figure 9-2 Incident Epidemiological Profiling Function 9 MaHIM: Concept of Operations
9 MaHIM: Concept of Operations Joseph A. Barbera, M.D. Anthony G. Macintyre, M.D. Mass Casualty Medical and Health Incident Management The Institute for Crisis, Disaster, and Risk Management Characteristics to consider when evaluating an anomaly as a possible or actual mass casualty incident are listed in Figure 9-3. This determination should be guided by a preestablished decision support tool, with decisions based upon event char- acteristics reaching trigger thresholds. If these conditions are present, a series of notifications is required. To facilitate information sharing during the uncer- tain time in which the rapid investigation is occurring, it is valuable to have a preplanned notification framework that incorporates a stepwise approach (both in information and in the notified parties) and does not automatically activate the entire system. An example of notification gradation can be found in Figure 9-4. At a minimum, the personnel designated as the community incident managers would receive an alert, as would the sur- veillance assets that must report additional information above their baseline data. If activation is implemented, all functions in MaHIM are notified. With any adequately sensitive surveillance system, anomalies will be detected that may not pose a significant medical threat to a community but that can cause fear and confusion if not investigated and explained. Structured management of anom- aly investigation, appropriate notification, and public infor- mation are vital. A likely sequence for managing such anom- alies is delineated in Figure 9-5. Even if an anomaly has been judged as non-credible or too low a threat to trigger systemwide action, this information should be conveyed throughout the system with an explana- tion as to how the determination was made. This promotes system functionality and “buy-in” and demonstrates system reliability. It prevents deleterious effects of misinformation and rumors coming from unofficial sources outside the response system. This public information will also minimize stress and anxiety that could be generated by potentially threatening events such as biological hoaxes.
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